I was lamenting Friday night’s court decision in Texas. Across from me was a doctor, a really smart guy, who was not displeased. Upon prodding he finally agreed that many people, perhaps millions of Americans, might have reason to be concerned, but not him. After all, his side, the politicians whom he has aligned himself with due to both financial and philosophical reasons, had won. He could intellectualize the entire health care debate, but he didn’t see statistics much less people. Like most doctors in Greater Cleveland, he works for a system. The system handles all the dirty tasks of billing and collection and organizing the access to care. He just provides health care to whoever ends up in front of him. He just does his job. I don’t know if the system beat the empathy out of him or if he ever had any. I’m guessing he can turn his empathy on and off and thinks of people like us as leaky faucets. The struggle to preserve the access and payment for health care continues. My conversation with this doctor convinced me that he isn’t on our team, and that’s a shame. Like I said, he’s a really smart guy and we’re going to need all of the help we can get.
Healthcare.gov, the access point for millions of Americans to purchase individual health insurance coverage, was forced to send out announcements that the Marketplace was still open today, the last day of Open Enrollment. Forced. After two years of sabotage by President Trump and his administration, there was real fear that the portal would be closed immediately. Their site has a banner stating “Court’s decision does not affect this season’s open enrollment.” I received my first client email moments after the decision hit the news. Clients called the office to inquire about their status. They needed to be reassured that nothing has changed, yet. Welcome to America 2018 where governing by cynicism has given way to governing by fear.
This blog chronicled the run-up to the passage of Obamacare, the Patient Protection and Affordable Care Act. There were more than enough disappointments, pork-barrel politics, and short cuts to fill these posts and tick off my Democratic friends. And we have now had eight cynical years of the politics of repeal. (No links. Most of the last eight years have dealt specifically with this BS.) As long as we’ve had divided government the Republicans have had the luxury of whipping up their base, collecting large campaign donations, and the safety of impotence. It was a game that they thought, like Risk, would go on forever. But they won in 2016 and now have to govern and their actions have consequences.
What is at stake? What are some of the key consumer elements of Obamacare?
- Guaranteed Issue
- Preexisting Conditions are covered
- No Health Screening – no penalty for previous illnesses or injuries
- MEDICAID EXPANSION – coverage extended to the working poor
- Tax Credit Subsidies – ongoing premium assistance that facilitates the purchase of coverage
- Cost Sharing Reduction – a reduction in the deductibles and out-of-pocket expenses
- Essential Health Benefits – compliant policies are comprehensive
- No Maximum Benefit – elimination of the annual and lifetime limits
If you repeal the law without an alternative you eliminate all of the above and more. And what Republican alternative is waiting in the wings. It took seven years for Mitch McConnell and crew to give us the American Health Care Act (AHCA), last year’s half-hearted attempt at a replacement. There have been no public hearings. There has never been an attempt to craft serious legislation. There has never even been a serious attempt to improve and adjust the current law.
There was a decision last night in Texas. Americans are nervous. The president of the Federation of American Hospitals is clearly ticked off. The American Medical Association had filed a brief in defense of the law. President Trump has declared this court ruling a great victory. Of course he has.
Picture – The Empty Field – David L Cunix